Insurers Pick Up More of Opioid Prescription Costs

Editor’s Note: If you want to learn more about the implications of opioid addiction and how your organization can minimize risk and cost impact – Join us for our free webinar on June 29th “The Hidden Impact of Opioid Addiction.” Dr. John Milne of Avnew Health discusses topics from decreasing incurred costs in your health plan to reducing abuse among patients. Click here to register.

The opioid epidemic is a real concern, not only for the patients and providers but also for payors and health plans. According to a study by the Centers for Disease Control and Prevention, there could be correlation between insurers picking up the costs opioid prescriptions and the rise of opioid related deaths.

The study, which was published on Health Affairs found that:

17% of spending on perception pain medicine in 2012, came from consumers paying out-of-pocket costs compared to a total of 53% in 1999

Out-of-pocket spending on opioid was down to 90 cents in 2012, compared to a whopping $4.40 in 2001

Medicare is the biggest payer for opioids and covers a total of between 20-30% of costs for patients. This study is spurring a conversation about more research on the payer side of opioid abuse. It is possible that if payers change their payment strategies and policies, to address opioid abuse, the results could lend to less “avoidable opioid-related mortality.

"BHM provides consultation and direct clinical oversight to East Carolina Behavioral Health as a delegated authority for clinical peer review and physician services. We have been extremely satisfied, and value the organization’s depth and breadth of knowledge. BHM continues to exceed our expectations."

Cindy Ehlers,
V P Clinical Operations, Trillium (formerly ECBH)

"6 of the top 10 largest health plans* entrust BHM for behavioral health peer reviews.